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Published in the Baker Street

Journal vol 41(4):230-234, 1991

Holmes's Service to Sir James Saunders

 

Robert J. Thomson

Los Alamos, New Mexico

As the world's foremost consulting detective, Sherlock Holmes performed many services that are only hinted at in the Canon. One such service was done for the eminent London dermatologist Sir James Saunders. In The Adventure of the Blanched Soldier Sherlock Holmes asked Sir James to accompany him to the home of Colonel Emsworth at Tuxbury Old Park, near Bedford, for the purpose of confirming what Holmes suspected about Emsworth's son, that is that he did not have leprosy. We are told by Holmes himself (for it is he who wrote this particular story) that he had asked Sir James to come along to give a second opinion: "... I have brought with me a friend whose discretion may absolutely be trusted. I was able once to do him a professional service, and he is ready to advise as a friend rather than as a specialist. His name is Sir James Saunders" (BLAN). It was quite a large favor to ask the elderly Sir James to come out to the country on a cool spring night, emotionally rewarding as it must have been for the old clinician.

Who was Sir James Saunders? Knighted by Queen Victoria for service to the realm, he was the most highly-respected consulting dermatologist in late Victorian England. The most puzzling and challenging dermatological cases in Great Britain were referred to him.

Dr. Robert Jackson of Ottawa, Ontario, Canada, has made the following arguments persuading the members of the Sir James Saunders Society, the dermatologic scion society of The Baker Street Irregulars, that Sir James was in real life Sir Jonathon Hutchinson.(1) Conan Doyle and Sir Jonathon were both physicians and happened to be neighbors. Sir Jonathon showed the same intense interest in leprosy as Sir James. Finally Sir James and Sir Jonathon exhibited very similar personal characteristics. The logo of the Society shows profiles of Holmes and Sir Jonathon.

Sir James, writing then under the name of Sir Jonathon Hutchinson, had an intense interest in a wide range of subjects. In order to bypass the usual need to satisfy a demanding editor and to avoid the effort needed to organize a formal textbook, he established his own journal, The Archives of Surgery. For ten years he wrote every article in it. These cover a wide range of topics, including dermatology, urology, ophthalmology, and general surgery.

What was the professional service for Sir James Saunders? We are not told whether this was a problem involving Sir James's private or professional life, but the association obviously did lead to a deep friendship between Holmes and Sir James. A personal problem would not likely lead to such a friendship, so it evidently was a problem relating to one of Sir James's many challenging clinical problems. It is easy to envision the pleasant evenings these two astute men no doubt passed together. We can gather hints about the friendship between them and the nature of the problems they faced from the writings of Sir James himself.

One interest that both men shared was bees. The science of genetics was in its earliest stages during Victorian times. There was great interest in the cellular processes involved in sexual reproduction and non-sexual cellular duplication. Mendelean genetics was known, but knowledge of DNA would wait for more than half a century. Sir James wrote about the sexual functions of honey bees:

How are drones, working bees, and queen bees respectively produced, and in what do they differ? The drones are male bees, and are produced from eggs which have not been impregnated; the workers are females, and are from impregnated eggs; the queen is a worker whose development has been increased and specialized by the liberal supply of a particular kind of food. Drones never show any tendency to collect honey; workers collect honey, but produce no eggs; the queens do not collect, but produce eggs. It is a mistake to call the workers "neuters," for their sex is only suppressed, and they are undoubtedly females. Can the workers (females in suppression) ever produce eggs? Yes; occasionally a worker is fertile and may lay eggs. They are, however, never susceptible of impregnation; and their eggs produce only drones.(2)

Holmes's keen sense of observation may have provided Sir James with the details that he reports, and Sir James may have sparked Holmes's lifelong interest in beekeeping. However, this does not seem to be truly a "professional" service, rather a bit of information exchanged between friends. Questions concerning chemistry also must have been discussed by these two friends. It is well known that Holmes was a highly skilled chemist.(3) He had a laboratory in his rooms at 221 B Baker Street and frequently performed experiments there. He used a Bunsen burner, test tubes, microscope, pipettes, litmus paper, and a distillation apparatus.

Evidence of Holmesís activity as a chemist include the nitric acid stains on his hands and the acid chars on the deal-top bench of his lab.(3) Sir James, too, was concerned with similar caustic chemicals, especially acid nitrate of mercury solution and chloride of zinc paste. Both strong caustics were commonly used by Sir James to treat "all unhealthy-looking sores, and wherever an inflammatory process was thought to be likely to prove infective to other parts" such as boils, inflamed acne, syphilis, arid tuberculosis in the skin.(4)

Organic chemistry was of concern to both men. Holmes was, of course, an expert in the coal-tar derivatives. During the Great Hiatus just prior to his return to London in April, 1894, he conducted chemical research in this field (EMPT). Holmes would have been primarily interested in the toxicological properties of the coal-tar derivatives and so developed expertise in the biological effects of such chemicals as carbolic acid, creosote, and tar.

In The Archives of Surgery Sir James used a format called a "Catechism of Surgery." In Number XCV he presented the "Effect of Tar, Carbolic Acid, &c., on the Urine.":

1. What is the effect of carbolic acid taken internally upon the urine?

2. Does its external use produce the same appearances?

3. Does creosote do the same?

4. Can the same be produced by tar ointment?

5. In any case of indigo-blue urine what should you suspect?

ANSWERS

1. It causes the urine to assume a smoky or black colour.

2. If absorbed by the skin, or from a wound, it easily does the same.

3. Creosote (as first noticed by Elliotson and Hughes) does the same, or in smaller doses makes the urine green.

4. Yes.

5. If the urine be exposed a few days to the air it becomes blue (creosote and indigo are closely allied substances). (5)

The combination of internal and external carbolic acid, creosote, and tar ointment was a standard treatment of the time. The tar ointment (pix carbonis) was a distillate product of wood. It was well known that sufficient absorption from topical use of these materials caused a smoky color to the urine.(6) Carbolic acid, whether from internal or topical use, is excreted in the urine in the form of phenyl-sulphuric acid, and this can be detected by analytical chemical means.

The need for this information must have arisen when Sir James intensively treated a patient suffering from either severe chronic eczema or psoriasis. The patient may have returned home from a few days' absence to find that he had neglected to empty his night pot before he left. There in the pot was bright blue urine. It must have been in some panic that he consulted Sir James to discover the truth of a dread disease that this blue urine might signify. For such a problem Holmes, with his vast store of knowledge about the coal-tar derivatives, was the logical person to whom to turn. Following a quick consultation with his old friend, Sir James was able to reassure his patient with confidence, just as he in turn reassured Holmes in The Adventure of the Blanched Soldier. Also a result of the friendship between these two men is the way Sir James's writings reflect Holmes's methods of careful observation, methods physicians seek to emulate today. On numerous occasions Sir James comments on the utmost importance of taking a good history from the patient. Without gathering all of the facts the physician will not likely arrive at a correct diagnosis or treatment. This was a lesson learned by the fireside from his friend Holmes.

Another field which Sir James learned from Holmes was that of disguise and deception. Holmes was a master at perpetrating and detecting both, and an alert physician must also be. There are many situations which could have been puzzling even to the expert clinician, so prompting him to seek the services of the expert detective. Sir James may have encountered a patient whose rash was beyond his diagnostic acumen. He was keenly aware of factitious diseases in his clinical practice:

A factitious disease is one induced by the patient intentionally. The object is usually to excite sympathy, to escape work or penalties, or sometime the mere pleasure of deceiving, and of claiming the interest of others.... The skin offers the most obvious field for the production of factitious symptoms of the objective class; and the practitioner must be constantly on his guard in reference to certain erratic forms of Dermatitis. The shape of the patches, their arrangement, and the conditions under which they relapse and recur, are the symptoms which usually aid the diagnosis.(7)

The areas of mutual interest thus far were suitable for exchange in a setting of growing mutual friendship and professional respect. There is one case report, however, in Sir Jamesís writings which stands out for its clear need for Holmesís professional service. Sir Jamesís own words best describe the case of a gunshot wound acquired under rather suspicious circumstances:

I was called late one night to a consultation of the whole surgical staff of the Poplar Hospital, in the case of a ship's captain who had been shot in the abdomen. An American passenger on board the vessel had at the end of his voyage, wishing to unload a pistol, discharged it upwards out of the cabin window. The captain chanced to be walking above, and received the bullet in his abdomen under the navel. There was no clue to the present position of the bullet. It was the third or fourth day after the accident, and all the signs of general peritonitis were present.

When I got to the hospital I found that all preparations had been made for opening the abdomen to search for the bullet. The abdomen was tense, tender, greatly distended, and the symptoms were very urgent. I represented to my colleagues, and particularly to Mr. Brownfield, whose patient the man was, that although it might perhaps be good surgery to explore, yet the manís condition was such that he might very likely die on the table, and that with such distension as was present it would be very difficult to return the intestines. It seemed probable that some important viscus was wounded, and but little likely that the operator would find it possible to repair the damage. We finally arrived at the conclusion (a rather cowardly one, possibly) not to interfere. My own belief was that the man would not live through the night under any circumstances, and that if his abdomen were once opened he would not live to have it closed again. We continued the treatment by hot poultices and opium which had been previously used.

To my great astonishment I heard from my friend Mr. Brownfield, some weeks later, that this patient had recovered. From the date of the consultation he had begun to improve, and he had since left the hospital quite well, still carrying the bullet with him.(8)

This case provides many interesting questions of circumstance and motive that would call for the services of the expert detective. Sir James may have sensed a deep, sinister evil in this tragic shooting. Was this truly an accident? Who was this mysterious American, what might his motive have been for shooting the unfortunate captain, and where did he go after the shooting? One can almost see Sir James being ushered into the sitting room at 221 B Baker Street to describe the case to Holmes and Watson. Alas, Watson leaves us with only sketchy hints about this case in the Canon.

The gravely wounded captain may have been the skipper of the Dutch steamship Friesland (NORW). The Friesland usually sailed between Antwerp and America(9) and must have regularly carried many Americans. The captain of a ship is the supreme legal authority aboard his ship, and he may have unwittingly discovered evidence of Professor Moriartyís complex schemes of crime being carried out by one of his American passengers. The Captain would have to be eliminated, but in a way that would appear to be an accident. The American owned the gun and must have been skilled in its use and care. He could not have been so stupid as to discharge this gun in order to unload it, and in such an irresponsible manner. There can be no doubt that this was a deliberate shooting. Of the American we hear nothing more. He disappeared into the complex criminal world of London.

The Captain was not expected to survive the shooting, but ultimately he did. Holmes and Watson must have interviewed him in the hospital, learning the secrets of the plot. Once word reached Moriarty that the Captain had indeed survived and had been in conversation with Holmes, there was great danger for both Holmes and Watson. Sir James, therefore, initiated that unreported adventure which nearly cost Holmes and Watson their lives (NORW). This was the professional service rendered by Sherlock Holmes, the investigation of the shooting of this sea captain. It was a service well performed and deserved a large favor from a friend in return.

 

REFERENCES

1. Robert Jackson, M.D. "Sir James Saunders: A Case of Identity." Paper presented at the Fourth Annual Meeting of the Sir James Saunders Society in Dallas, Texas, 5 December 1977.

2. Archives of Surgery II, 179-180, 1891.

3. Robert H. Dinegar "Sherlock Holmes, Scientist and Chemist." Presented at the 1985 Annual Meeting of the American Association for the Advancement of Science, 30 May, 1985, Los Angeles, California.

4. Archives of Surgery III, 169, 1892.

5. Archives of Surgery III, 273ó274, 1892.

6. Alexander Wynter Blyth. Poisons, Their Effects and Detection (New York: William Wood & Company, 1885), pp. 142-161.

7. Archives of Surgery III, 381, 1892.

8. Archives of Surgery II, 14, 1891.

9. Donald A. Redmond. "Ship Ahoy, Captain Basil", BSJ (Ns) 36 (December 1986): 223ó230.